Talking about death eases end of life for patients, loved ones

Excerpts from the Globe's blog on the Boston-area medical community.

Talking about death with patients near the end of life did not heighten their distress, a study of dying cancer patients found, but instead led to greater comfort for the patients and their loved ones.

Researchers led by Dr. Alexi Wright of the Dana-Farber Cancer Institute report in the Journal of the American Association on interviews with 332 terminally ill cancer patients recruited at seven outpatient clinics. Patients who said they did not have end-of-life conversations got significantly more aggressive care in their final week of life, which was linked to lower quality of life near death. Their caregivers also suffered, feeling regret, poor quality of life, and a higher risk of developing depression.

Patients who said they did have end-of-life discussions were more likely to have a better quality of life in their last days, less likely to get aggressive care, and more likely to receive hospice services. Their loved ones said they felt less regret, and better quality of life, during their bereavement.

"Our results suggest that end-of-life discussions may have cascading benefits for patients and their caregivers," the authors wrote.

Children who receive free samples of prescription drugs from their doctors may be risking safety problems, a new study says.

Four of the 15 medications most frequently given out as free samples to more than 10,000 children in a 2004 national survey later had black-box warnings placed on them or significant changes made to these safety warnings, researchers from Cambridge Health Alliance and Hasbro Children's Hospital report in Pediatrics. Black-box warnings - named for their appearance on drug information given to prescribers - are the strongest cautions the Food and Drug Administration gives.

"I think the safety of free drug samples must be further examined," Dr. Sarah L. Cutrona, lead author and an internal medicine specialist at Cambridge Health Alliance, said in an interview. "Giving free samples to children in nonurgent situations is really an unproven medical practice that should be undertaken very cautiously or perhaps needs to stop."

Cutrona and her colleagues found that 1 out of 10 children who take prescription medications received free samples and nearly 1 in 20 children overall got free samples in 2004. But poor children or uninsured children were no more likely to get free samples than children who had insurance or whose families were better off.

Internal medicine and family practice physicians are in critically short supply in Massachusetts, according to a poll of doctors in the state.

The Massachusetts Medical Society reports in its seventh annual Physician Workforce Survey that the two primary care specialties join 10 other types of medical practice that are experiencing shortages. Oncologists, neurologists, and dermatologists are also on the list of doctors in high demand. The other seven specialties are anesthesiology, emergency medicine, general surgery, neurosurgery, psychiatry, urology, and vascular surgery.

The survey asked doctors, hospital heads, and leaders of medical education about how long it took patients to get a doctor's appointment, or be referred to a specialist. It also asked about recruiting and retaining physicians, and keeping newly trained doctors in Massachusetts.

Wait times for new patients changed slightly from last year: down to 50 days (from 52) to get an internal medicine appointment and up to 36 days (from 34) to see a family medicine doctor. A survey of physician offices found that 42 percent of internal medicine and 35 percent of family medicine practices were closed to new patients.

"Universal coverage does not equal universal access," society president Dr. Bruce Auerbach said in a statement released with the report. "With more patients, an aging population, and rising rates of obesity and chronic disease, demand is overwhelming supply, and our physician workforce is coming under more stress and strain."

Just days after federal regulators held hearings on how to evaluate over-the-counter cough and cold medications that have never been tested in children, the nation's largest research organization is reaching out to parents to explain how clinical trials for children work.

The National Institutes of Health is launching a web site today that invites parents to consider the importance of research to find out whether medications or treatments are safe and effective in children. Video interviews on the site spell out potential risks and benefits, address concerns of minority groups, and suggests suggest questions to ask before participating.

The Food and Drug Administration last week took up the question of pediatric cough and cold remedies on sale for years based on data that was extrapolated from adults to children. The health officials decided against a ban while noting the lack of evidence to support use of the medicines in children.

ELIZABETH COONEY